Healthcare Provider Details

I. General information

NPI: 1144139346
Provider Name (Legal Business Name): JACQUELINE GREENMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S OLD GLEBE RD
ARLINGTON VA
22204-1739
US

IV. Provider business mailing address

5903 MOUNT EAGLE DR APT 305
ALEXANDRIA VA
22303-2526
US

V. Phone/Fax

Practice location:
  • Phone: 703-228-5820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2204001541
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: